椎旁阻滞对肺癌根治术患者术后镇痛效果及外周血肿瘤标志物水平的影响

发布时间：2018-06-05 06:41

本文选题：椎旁神经阻滞 + 肺肿瘤　；参考：《中国肺癌杂志》2015年02期

【摘要】：背景与目的围术期疼痛质量管理与肿瘤患者的预后相关,优化围术期镇痛方法,进而减轻围术期应激反应,减少阿片类药物用量从而减轻甚至避免由此引起的全身性不良反应和肿瘤标志物水平升高。肺癌患者血清中肿瘤标志物水平与肿瘤发展密切相关,国内外文献未见报道区域阻滞对肺癌肿瘤标志物的影响。本研究评价胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后镇痛效果及外周血肿瘤标志物水平的影响。方法采用随机数字表法将患者分为两组(各20例):单纯全麻组(G组)和胸椎旁神经阻滞(paravertebral block,PVB)复合全麻组(GP)组。G组采用静脉诱导,静吸复合麻醉维持;GP组诱导前患者清醒时行PVB,PVB效果通过测定阻滞范围来判断,PVB起效后静脉诱导,静吸复合麻醉维持。两组均于术毕缝皮时启动静脉镇痛泵行患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)。分别于术后2 h、24 h和48 h行视觉模拟评分(visual analogue scale,VAS),记录按压次数以及镇痛药用量。分别于术前及术后24 h取两组患者的静脉血样本,检测肿瘤标志物癌胚抗原、糖链抗原199、糖链抗原125、神经元特异性烯醇化酶、细胞角质蛋白19片段的浓度。结果择期行胸腔镜肺癌根治术患者40例,性别不限,年龄20岁-70岁,体重指数(body mass index,BMI)18 kg/m2-25 kg/m2,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级I级或II级。术后2 h,GP组患者的VAS评分明显低于G组(P=0.013);术后24 h,GP组患者的VAS评分也明显低于G组(P=0.025);GP组术后24 h、48 h启动自控按钮次数明显少于G组(P值分别为0.021、0.026);GP组24 h、48 h PCIA泵的输注总量明显低于G组(P值分别为0.006、0.011)。术后24 h,两组患者肿瘤标志物水平与术前比较变化不大(P0.05);比较两组患者肿瘤标志物水平,手术前后的差值差异无统计学意义(P0.05)。结论胸椎旁神经阻滞可明显减轻胸腔镜肺癌根治术患者术后疼痛并减少静脉镇痛泵内阿片类药物用量;胸椎旁神经阻滞对胸腔镜肺癌根治术患者肿瘤标志物水平无明显影响。
[Abstract]:Background and objective Perioperative pain quality management was associated with the prognosis of tumor patients, and the perioperative analgesia method was optimized to alleviate perioperative stress response. Reduce opioid use to reduce or even avoid systemic adverse reactions and elevated tumor markers. The level of tumor markers in serum of patients with lung cancer is closely related to the development of tumor. The influence of regional block on tumor markers of lung cancer has not been reported in domestic and foreign literature. This study was to evaluate the effect of paraspinal thoracic nerve block on postoperative analgesia and tumor markers in peripheral blood of patients undergoing thoracoscopic radical resection of lung cancer. Methods the patients were randomly divided into two groups (20 cases each: group G: simple general anesthesia) and group G (combined with paravertebral block PVB). Group G was induced by vein. The effect of PVB combined with PVB before induction in GP group was determined by measuring the range of block to determine the intravenous induction after the onset of PVB and the maintenance of combined intravenous anesthesia. In both groups, patient controlled intravenous analgesia was performed by starting intravenous analgesia pump at the end of suture skin operation. Visual analogue score (VAS) was performed at 24 h and 48 h after operation, respectively. The times of compression and the dosage of analgesics were recorded. Venous blood samples of the two groups were taken before and 24 hours after operation to detect the tumor markers carcinoembryonic antigen, carbohydrate antigen 199, carbohydrate chain antigen 125, neuron-specific enolase and cytokeratin 19 fragment. Results there were 40 patients with elective thoracoscopic radical resection of lung cancer, male and female, aged 20-70 years, body mass index (BMI) mass BMI-18 kg/m2-25 / kgm2, American Society of anesthesiologists ASA-grade I or II. The VAS scores of patients in group GP at 2 h after operation were significantly lower than those in group G (P 0.013), and the scores of VAS in group GP 24 h after operation were significantly lower than those in group G (P = 0.021 1 / 0.026, P = 0.021 / 0.026, P = 0.021 / 0.026, respectively). The total volume of infusion was significantly lower than that of group G (P = 0.006). 24 hours after operation, the level of tumor markers in the two groups did not change significantly compared with those before operation, but there was no significant difference between the two groups in the level of tumor markers before and after operation (P 0.05). Conclusion Thoracic paravertebral nerve block can significantly reduce postoperative pain and the dosage of opioid drugs in intravenous analgesia pump in patients with lung cancer under thoracoscopic radical operation, and there is no significant effect of paraspinal nerve block on tumor markers in patients undergoing thoracoscopic radical resection of lung cancer.
【作者单位】：北京大学肿瘤医院;北京市肿瘤防治研究所麻醉科;北京市肿瘤防治研究所胸外一科;
【分类号】：R734.2

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